Hip Pain in Children
Hip Pain in Children
Hip Pain in Children
Ferbile
Afebrile
Septic arthritis
Perthes disease
Reactive arthritis
Osteomyelitis
Transient synovitis
DDH
Mechanical: trauma, sports injury
1-3 yo
3-10 yo
Transient synovitis
Septic arthritis, osteomyelitis
Trauma
Perthes disease
JIA
Malignancy
11-16yo
Septic arthritis
<2 yo
Staphylococcus aureus, by haematogenous spread/ local
spread from osteomyelitis
Involve 1 joint (hip)
Clinical features: erythematous, tender joint, hip held in
flexion, abduction, external rotation, pseudoparalysis,
unwell, febrile child
Investigation:
FBC: raised WCC
ESR, CRP: raised
Blood culture: may be positive
X ray of affected joint: soft tissue swelling,
widening of joint space, evidence of osteomyelitis
US: effusion. Positive echogenic-septic arthritis,
echo free-transient synovitis
Joint aspiration (definitive IX): gross and
microscopic examination, culture and sensitivity.
Purulent, raised WCC, low glucose, low viscosity,
bacteria present
Kocher criteria
Treatment
Symptomatic :
Analgesia and IV fluid
Antibiotic: ex: cloxacilin
Hip joint on traction/splinting in abduction
Surgical:
Surgical drainage
Arthrotomy (arthroscopic debridement and copious
irrigation with normal saline)
Indication:
Transient synovitis
Perthes disease
Lateral epiphyseal
vessel in retinacula
susceptible to stretching
by effusion and pressure